Medical marijuana is now officially legal in Mexico, but rules and regulations will take some time.

Marijuana Policy

New Jersey Legalization Bill Gets Hearing. The Senate Judiciary Committee held a hearing on a legalization measure, Senate Bill 3195, on Monday. The testimony was largely favorable, including from a former state Republican Committee head, the head of a doctors' organization favoring legalization, and from a long-time municipal prosecutor. "I believe by legalizing and regulating it and discouraging, officially as official government policy, like we do with tobacco and alcohol, we will be far better off than the status quo," prosecutor J.H. Barr told the committee. No vote was taken. The bill is strongly opposed by Gov. Chris Christie (R), but he'll be gone in January.

Vermont Legislators Will Try to Get Weed Legalized in Special Session This Week. Gov. Phil Scott (R) vetoed the legalization bill in May, saying he had public safety concerns. Supporters of legalization have come back with a bill that now has stiffer penalties for drugged driving, smoking pot in cars with kids, providing pot to kids, and selling pot in school zones -- all in a bid to win the governor's support. The bill does not include "impairment testing mechanism" requested by Scott, largely because there are no marijuana breathalyzers on the market. Scott has declined to comment on the revised bill. The special session begins Wednesday.

Harm Reduction

Boston Ponders Supervised Injection Sites. With six people a day dying of opioid overdoses in the city so far this year, the city council has set a hearing next Monday to explore the potential impact of supervised injection sites. The move comes after the Massachusetts Medical Society urged state officials to open at least two of the facilities.

International

China Bans Synthetic Opioids Linked to US Overdose Deaths. China announced on Monday that it is banning the ultra-potent synthetic opioid U-47700 and three others. The DEA says China is the chief source of synthetic opioids, including fentanyl and carfentanil, which China has already banned. U-47700, MT-45, PMMA, and 4,4-DMAR will be added to the country's list of controlled substances as of July 1, said Deng Ming, deputy director of the National Narcotics Control Commission.

Mexico Legalizes Medical Marijuana. President Enrique Pena Nieto issued a decree on Monday officially legalizing medical marijuana in the country. Legislation authorizing medical marijuana sailed through the Senate in December and passed the lower house on a 347-7 vote in April. Now, the Ministry of Health will be tasked with drafting and implementing rules and regulations.

The politics of marijuana regulation continue to roil Massachusetts, Trump adviser and political trickster Roger Stone has formed a legalization lobbying group, the government of the Republic of Georgia backs away from harsh pot sentences, and more.

What is political trickster Roger Stone up to? (alternet.org)

Marijuana Policy

Trump Associate Roger Stone Forms Legalization Lobbying Group. Longtime political trickster and Donald Trump associate Roger Stone announced last Friday that he has formed the United States Cannabis Coalition for the express purpose of legalizing marijuana. He will be joined by former Minnesota Gov. Jesse Ventura (I), as well as both Democratic and Republican political strategists. "I am going to be working with a coalition of Republicans and Democrats, progressives and libertarians, liberals, and conservatives to persuade the president to keep his campaign pledge," Stone said, "and to remind the president that he took a strong and forthright position on this issue in the election." During the campaign, Trump said marijuana legalization should be a state issue and that he was "100%" behind medical marijuana.

Massachusetts Senate Plan Would Not Raise Taxes. State Sen. Patricia Jehlen (D-Somerville) last Friday released the Senate's plan to implement marijuana legalization, a sharp contrast with the House bill that would raise the tax rate on marijuana from 12% to 28% and allow local elected officials to ban pot businesses. Jehlen's bill would keep the tax rate at the 12% envisioned by last fall's successful initiative. "A high tax rate is not the will of the voters," she said after releasing the outline of the Senate bill. "You want to start low enough to make the legal market catch hold." The two bills should pass their respective houses and go to conference committee later this month.

Mobile Retreats from Decriminalization Ordinance. Mobile, Alabama, Mayor Sandy Stimpson has requested that discussion of a municipal ordinance to decriminalize marijuana possession be withdrawn from the agenda for Tuesday's city council meeting. The reason for the withdrawal is unclear, but the topic has been controversial with law enforcement and city staff.

Medical Marijuana

Arkansas Medical Marijuana Regulations Take Another Key Step. The Legislative Council, which serves as the legislature's governing body between sessions, last Friday approved draft rules from the Alcoholic Beverage Commission, the Department of Health, and the Medical Marijuana Commission aimed at regulating the state's nascent medical marijuana system. The state will begin accepting applications for licenses to operate marijuana cultivation centers and dispensaries June 30.

After Protests, Georgia Marijuana Reform Bill Filed. The government has filed a bill in parliament that would end prison sentences for the possession, cultivation, or sale of less than 70 grams (a bit more than a quarter-pound) of marijuana. The move comes after mass protests last weekend over the arrests of two rappers on what are widely believed to be trumped-up marijuana charges for releasing videos critical of police. The bill would also slash by nearly half prison sentences for marijuana offenses involving larger quantities.

Marijuana policy continues to roil statehouses across the Northeast, a US senator and a congressman file identical medical marijuana protection bills, Louisiana -- the lock 'em up state -- enacts comprehensive sentencing reforms, and more.

Marijuana Policy

Massachusetts to Get New Legalization Rewrite Bill on Monday. After criticism and errors in the text force the House leadership to pull its marijuana legalization rewrite bill this week, House committee chair Rep. Mark Cusack (D-Braintree) said a redrafted version of the bill would be released on Monday, with debate expected in the House on Wednesday. At issue are tax rates and a governance model for the industry.

Rhode Island Legalization Advocates Offer Compromise Bill. Rep. Scott Slater (D-Providence) and Sen. Joshua Miller (D-Cranston), along with Regulate Rhode Island, have outlined a compromise bill that would legalize the possession of up to an ounce of marijuana starting July 1, 2018, with an advisory board to study the effects of legalization and report to the General Assembly next year on setting up a taxed and regulated system of marijuana commerce. Assembly leaders are pushing a bill that would defer legalization until a legislative commission studies the issue.

Vermont Governor Says Legalization Deal Still Possible. Gov. Phil Scott said Thursday an agreement with legislators on marijuana legalization is still possible this year. Scott vetoed the legalization bill last month, citing concerns about drugged driving and children. "We are still negotiating," Scott said. "They understand... what my reservations are in terms of what they're planning, but I still think it's workable." If an agreement is reached, House Republicans would have to agree to suspend the rules of the veto session to allow a vote on the pot bill. They do not sound very interested in that, but Scott has said that if he can reach agreement on a bill, he will try to persuade his GOP colleagues to allow a vote.

Michigan Lawmakers File Medical Marijuana Billboard Ad Ban Bills. State Sen. Rick Jones (R) and Rep. Andy Schor (D) have filed identical bills that would effectively ban billboard for medical marijuana businesses. The bills are Senate Bill 463 and House Bill 4767. They are not yet available on the state legislative web site.

Pennsylvania Governor Warns Session Against Interfering with Medical Marijuana. In a sharply worded letter, Gov. Tom Wolf (D) warned Attorney General Jeff Sessions not to interfere with medical marijuana in the state. "For a lot of patients, this is the only medicine that works. So for him to go after medical cannabis is kind of flying in the face of science and the facts," said a spokesman for the governor.

Criminal Justice

Louisiana Enacts Comprehensive Criminal Justice Reforms. Gov. John Bel Edwards (D) on Thursday signed a package of 10 bills that shrink sentences, mostly for nonviolent offenders, and expand parole and probation and reentry opportunities for offenders. The state has the highest proportion of its population behind bars of any state, but Edwards predicts that the new laws will see the state's prison population falling by as much as 10% in the next decade. The bills are House Bills 116, 249, 489, 519, 680 681 and Senate Bills 16, 139, 220, 221. They can be viewed at the state legislative website.

International

British Columbia Court Throws Out Mandatory Minimums for Marijuana Producers. The BC Court of Appeals last week threw out the mandatory minimum sentence for people caught producing more than six marijuana plants, saying the law mandating it was unconstitutional. "I note that a six-month sentence is typical for a first-time trafficker involved in a relatively sophisticated commercial dial-a-dope operation. Imposing that sentence on a 19-year-old student or a migraine sufferer who is growing six plants intending to share them with friends would, in my view, be abhorrent to most Canadians," the trial court judge held, instead giving the man a suspended sentence. The government appealed, and lost last week.

A bipartisan group of senators reintroduce the CARERS Act to protect medical marijuana in the states, marijuana legalization is keeping legislators busy in the Northeast, New York GOP senators want more drug war to fight opioids, and more.

Kirsten Gillibrand (D-NY) is among a bipartisan group of senators who reintroduced the CARERS Act today. (senate.gov)

Marijuana Policy

Massachusetts Legal MJ Rewrite Bill Delayed By Errors, Concern at High Tax Rates. House Speaker Robert DeLeo (D-Winthrop) has postponed a vote on the legislature's rewrite of the marijuana legalization law approved by voters last fall after errors in the drafting of the bill and the high tax rate proposed -- 28% -- drew protests from Democratic lawmakers. "I think there are certain things that we have to clear up, so because of that, I think it's important that with a bill of this mag that we try to get it right or close to right this first time, so I'd rather do that than try to rush it through," DeLeo said, adding that there was a consensus among Democrats on the basics of the bill.

New Jersey Legalization Bill Gets Hearing Monday. The Senate Judiciary Committee will hold a hearing Monday morning on Senate Bill 3195, which legalizes the possession of small amounts of marijuana and sets up a system of taxed and regulated marijuana commerce. The Drug Policy Alliance has expressed "concern" that the bill "does not include essential components to create a fair and equitable marijuana market in New Jersey." Such legislation must include polices to repair past harms to minority communities, DPA said.

Rhode Island Legalization Study Commission Bill Passes House. A bill that creates a legislative commission to study marijuana legalization -- instead of just legalizing it -- passed the House Wednesday night. House Bill 551A now heads to the Senate. Regulate Rhode Island, the main advocacy group for legalization, has said it will not participate in the commission, which it describes as a delaying tactic.

Medical Marijuana

Bipartisan Bill to End Federal Prohibition of Medical Marijuana Reintroduced in US Senate. US Sens. Rand Paul (R-KY), Corey Booker (D-NJ), and Kirsten Gillibrand (D-NY) reintroduced a bill Thursday that would end the federal prohibition of medical marijuana. Sens. Mike Lee (R-UT) and Lisa Murkowski (R-AK) also signed on to the legislation as original cosponsors. The Compassionate Access, Research Expansion, and Respect States (or CARERS) Act of 2017 would allow individuals and entities to possess, produce, and distribute medical marijuana if they are in compliance with state medical marijuana laws. It would also open up avenues to medical marijuana research and allow physicians employed by the Department of Veterans Affairs to recommend medical marijuana to veterans in states where it is legal. The bill also proposes excluding cannabidiol, a non-psychoactive cannabinoid found in marijuana, from the federal government's definition of "marijuana."

Kentucky Lawsuit Challenges State's Medical Marijuana Ban. Three Kentuckians who say they have used marijuana to ease health problems have filed a lawsuit in state court charging that banning medical marijuana violates their constitutional privacy rights. The suit names as defendants Gov. Matt Bevin (R) and Attorney General Steve Beshear (D).

Rhode Island Governor Proposes Medical Marijuana Expansion. Gov. Gina Raimondo (D) has proposed a budget amendment that calls for "no less than six licensed compassion centers" and increased licensing fees that would generate $1.5 in revenues for the state's general fund. There are three existing dispensaries, which would each be allowed to open one more store front, plus the three additional ones proposed.

Heroin and Prescription Opioids

New York Republicans Want More Drug War to Fight Opioids. A Republican Senate task force says that adding funding for addiction treatment is good, but that it's time to increase heroin penalties "to get dealers off the street." The senators are proposing charging dealers with murder if one of their customers dies and increasing penalties based on the weight of the drugs sold. Assembly Democrats rejected the idea, calling the approach one that's been "tried and failed." The Assembly killed a similar approach last year.

On Monday, it was reported that Attorney General Sessions asked Congress to let him go after medical marijuana. Attorney General Sessions sent a letter to Congress last month asking leading members to reject a federal law letting medical marijuana states set their own policies. The Rohrabacher-Farr amendment to the Justice Department budget bars the use of federal funds to prevent states "from implementing their own State laws that authorize the use, distribution, possession or cultivation of medical marijuana." In a letter urging congress members to walk back the amendment, Sessions said the law would "inhibit [his department's] authority to enforce the Controlled Substances Act." Hat tip to Tom Angell at MassRoots, who first obtained the letter.

Arizona

Last Thursday, the state attorney general asked the state Supreme Court to reinstate a ban on campus medical marijuana. Attorney General Mark Brnovich (R) has asked the state Supreme Court to review an appeals court ruling that struck down a ban on medical marijuana on college campuses. The state is arguing that the legislature had the right to alter the voter-approved medical marijuana law so that college students with medical marijuana cards could face felony arrests for possession of any amount of marijuana.

Connecticut

Last Friday, the state took another step toward adding more qualifying conditions. Consumer Protection Commissioner Michelle Seagull announced that she would follow a recommendation from the Medical Marijuana Program Board of Physicians to include three new conditions among the list of qualifying conditions for medical marijuana use. They are hydrocephalus with intractable headaches, intractable migraines, and trigeminal neuralgia. Seagull will now draft a new regulation by the end of the month, and after that, there will be a 30-day public comment period, then a review by the office of the attorney general, and then the approval of the Regulation Review Committee of the General Assembly. The whole process could take another year.

Florida

Last Friday, the medical marijuana implementation bill passed the legislature. Lawmakers used a special session to come to an agreement on how to handle medical marijuana. Under the proposal approved by the legislature, which Gov. Rick Scott (R) says he will sign, the state will gain an additional ten medical marijuana operators within four months. Each operator can operate up to 25 dispensaries across the state. But the bill also bans the smoking of medical marijuana even though the constitutional amendment approved by voters last November expressly included a provision that allows smoking. That has led Orlando lawyer John Morgan, who largely bankrolled the amendment, to vow to sue the state over the no-smoking provision.

Vermont

Last Thursday, the governor signed a medical marijuana expansion bill. Gov. Phil Scott (R) signed into law Senate Bill 16, which expands the list of qualifying conditions for medical marijuana. The new conditions added are Parkinson's disease, Crohn's disease, and PTSD. The new law also increases the number of dispensaries in the state from four to five.

Nevada Lawsuit That Threatens July 1 Sales Date Still Alive. A Carson City district court judge on Tuesday denied the state's motion to dismiss a lawsuit brought by liquor distributors seeking a cut of the action in the state's emerging legal marijuana industry. The liquor distributors have won a temporary restraining order holding up the implementation of the state's marijuana sales law until their lawsuit is settled. The distributors claim the state's regulations for licensing marijuana distributors are arbitrary and unfair. This means the state's early July 1 legal sales goal is in jeopardy.

Rhode Island Legislature to Vote on Study Bill, But Advocates Say No Thanks. Marijuana legalization supporters said Wednesday they will not participate in a legalization study commission if it is approved by the General Assembly, calling it "a flawed delay tactic." Instead, Regulate Rhode Island is calling on legislative leaders to vote on a bill that would legalize personal possession and cultivation, but include no immediate plans for taxed and regulated marijuana commerce.

Vermont Governor, Legislative Leaders Move Toward Compromise on Legalization. After Gov. Phil Scott (R) vetoed the legalization bill, Senate Bill 16, he said he didn't oppose legalization in principle, but had concerns about youth use and impaired driving. He also said he wanted a study commission in the bill to have more time to examine how the state could implement legal marijuana commerce. Now, legislative leaders say they have come up with compromise language that addresses his concerns, including tougher penalties for selling to children and longer sentences for smoking in a car when a child is present. A spokesman for the governor said "We're making good progress toward an agreement." Legislators will need Republicans to waive a rule to bring the issue up for consideration during a looming special session, but Scott said if an agreement on the bill could be reached, he would seek to persuade Republican legislators to allow it to be taken up.

Medical Marijuana

Attorney General Session Asked Congress to Let Him Go After Medical Marijuana. Attorney General Sessions sent a letter to Congress last month asking leading members to reject a federal law letting medical marijuana states set their own policies. The Rohrabacher-Farr amendment to the Justice Department budget bars the use of federal funds to prevent states "from implementing their own State laws that authorize the use, distribution, possession or cultivation of medical marijuana." In a letter urging congresspeople to walk back the amendment, Sessions said the law would "inhibit [his department's] authority to enforce the Controlled Substances Act." Hat tip to Tom Angell at MassRoots, who first obtained the letter.

Drugs, mainly opioids, are killing Americans at a record rate. The number of drug overdose deaths in the country quadrupled between 1999 and 2010 -- and compared to the numbers we're seeing now, those were the good old days.

Some 30,000 people died of drug overdoses in 2010. According to a new estimate from the New York Times, double that number died last year. And the rate of increase in overdose deaths was growing, up a stunning 19% over 2015.

The Times' estimate of between 59,000 and 65,000 drug overdose deaths last year is greater than the number of American soldiers killed during the entire Vietnam War, greater than that number of people killed in the peak year for car crash deaths, greater than the number of people who died in the year the AIDS epidemic peaked, and higher than the peak year for gun deaths.

In the first decade of the century, overdoses and addiction rose in conjunction with a dramatic increase in prescription opioid prescribing; since then, as government agents and medical professionals alike sought to tamp down prescribing of opioids, the overdose wave has continued, now with most opioid OD fatalities linked to illicit heroin and powerful black market synthetic opioids, such as fentanyl and carfentanil.

The Centers for Disease Control and Prevention says we are in the midst of "the worst drug overdose epidemic in history," and it's hard to argue with that.

So, what do we do about it? Despite decades of failure and unintended consequences, the prohibitionist reflex is still strong. Calls for more punitive laws, tougher prosecutorial stances, and harsher sentences ring out from state houses across the land to the White House. But tough drug war policies haven't worked. The fact that the overdose and addiction epidemic is taking place under a prohibition regime should make that self-evident.

More enlightened -- and effective -- approaches are now being tried, in part, no doubt, because today's opioid epidemic is disproportionately affecting white, middle class people and not the inner city black people identified with heroin epidemics of the past. But they are also being tried because for the past quarter-century an ever-growing drug reform movement has articulated the failures of prohibition and illuminated more effective alternatives.

The drug reform movement's most powerful organization, the Drug Policy Alliance, this spring published A Public Health and Safety Approach to Problematic Opioid Use and Overdose, which lays out more than two dozen specific policy prescriptions in the realms of addiction treatment, harm reduction, prevention, and criminal justice that have been proven to save lives and reduce dependency on opioids. These policy prescriptions are doable now -- and some are being implemented in some fashion in some places -- but require that political decisions be made, or that forces be mobilized to get those decisions made. Some would require a radical divergence from the orthodoxies of drug prohibition, but that's a small price to pay given the mounting death toll.

Here are 24 concrete policy proposals that can save lives and reduce addiction right now. All the facts and figures are fully documented in the heavily-annotated original. Consult it if you want to get down to the nitty-gritty. In the meantime:

Addiction Treatment

1. Create Expert Panel on Treatment Needs: States should establish an expert panel to address effective treatment needs and opportunities. The expert panel should evaluate barriers to existing treatment options and make recommendations to the state legislature on removing unnecessary impediments to accessing effective treatment on demand. Moreover, the panel should determine where gaps in treatment exist and make recommendations to provide additional types of effective treatment and increased access points to treatment (such as hospital-based on demand addiction treatment). The expert panel must also set evidence-based standards of care and identify the essential components of effective treatment and recovery services to be included in licensed facilities, especially with regards to medication-assisted treatment, admission requirements, discharge, continuity of care and/or after-care, pain management, treatment programming, integration of medical and mental health services, and provision of or referrals to harm reduction services. The expert panel should identify how to improve or create referral mechanisms and treatment linkages across various healthcare and other providers. The panel should establish clear outcome measures and a system for evaluating how well providers meet the scientific requirements the panel sets. And, finally, the expert panel should evaluate opportunities under the ACA to expand coverage for treatment.

2. Increase Insurance Coverage for Medication-Assited Treatment (MAT): Seventeen state medical plans under the Patient Protection and Affordable Care Act (ACA) do not provide coverage for methadone or buprenorphine for opioid dependence. Moreover, the Veterans Administration's (VA's) insurance system has explicitly prohibited coverage of methadone and buprenorphine treatment for active duty personnel or for veterans in the process of transitioning from Department of Defense care. As a result, veterans obtaining care through the VA are denied effective treatment for opioid dependence. Insurance coverage for these critical medications should be standard practice.

3. Establish and Implement Office-Based Opioid Treatment for Methadone: Currently, with a few exceptions, methadone for the treatment of opioid dependence is only available through a highly regulated and widely stigmatized system of Opioid Treatment Programs (OTPs). Moreover, several states have imposed moratoriums on establishing new OTPs that facilitate methadone treatment despite large, unmet treatment needs for a growing opioid-dependent population. Patients enrolled in methadone treatment in many communities are often limited to visiting a single OTP and face other inconveniences that make adherence to treatment more difficult. Initial trials have suggested that methadone can be effectively delivered in office-based settings and that, with training, physicians would be willing to prescribe methadone to their patients to treat their opioid dependence. Office-based methadone may help reduce the stigma associated with methadone delivered in OTPs as well as provide a critical window of intervention to address medical and psychiatric conditions. Office-based opioid treatment programs offering methadone have been implemented in California, Connecticut, and Vermont.

4. Provide MAT in Criminal Justice Settings, Including Jails/Prisons and Drug Courts: Individuals recently released from correctional settings are up to 130 times more likely to die of an overdose than the general population, particularly in the immediate two weeks after release. Given that approximately one quarter of people incarcerated in jails and prisons are opioid-dependent, initiating MAT behind bars should be a widespread, standard practice as a part of a comprehensive plan to reduce risk of opioid fatality. Jails should be mandated to continue MAT for those who received it in the community and to assess and initiate new patients in treatment. Prisons should initiate methadone or buprenorphine prior to release, with a referral to a community-based clinic or provider upon release. In addition, drug courts should be mandated to offer participants the option to participate in MAT if they are not already enrolled, make arrangements for their treatment, and should not be permitted to make discontinuation of MAT a criterion for successful completion of drug court programs. The Substance Abuse and Mental Health Services Administration will no longer provide federal funding to drug courts that deny the use of MAT when made available to the client under the care of a physician and pursuant to a valid prescription. The National Association of Drug Court Professionals agrees: "No drug court should prohibit the use of MAT for participants deemed appropriate and in need of an addiction medication."

Medication-Assisted Treatment (MAT) can help.

5. Offer Hospital-Based MAT: Emergency departments should be mandated to inform patients about MAT and offer buprenorphine to those patients that visit emergency rooms and have an underlying opioid use disorder, with an appointment for continued treatment with physicians in the community. Hospitals should also offer MAT within the inpatient setting, and start MAT prior to discharge with community referrals for ongoing MAT.

6. Assess Barriers to Accessing MAT to Increase Access to Methadone and Buprenorphine: A number of known barriers prevent MAT from being as widely accessible as it should be. The federal government needs to reevaluate the need for and effectiveness of the OTP model and make necessary modifications to ensure improved and increased access to methadone. And, while federal law allows physicians to become eligible to prescribe buprenorphine for the treatment of opioid dependence, it arbitrarily caps the number of opioid patients a physician can treat with buprenorphine at any one time to 30 through the first year following certification, expandable to up to potentially 200 patients thereafter. Moreover, states need to evaluate additional barriers created by state law, including, among others, training and continuing education requirements, restrictions on nurse practitioners, insurance enrollment and reimbursement, and lack of provider incentives.

7. Establish and Implement a Heroin-Assisted Treatment Pilot Program: Heroin-assisted treatment (HAT) refers to the administering or dispensing of pharmaceutical-grade heroin to a small and previously unresponsive group of chronic heroin users under the supervision of a doctor in a specialized clinic. The heroin is required to be consumed on-site, under the watchful eye of trained professionals. This enables providers to ensure that the drug is not diverted, and allows staff to intervene in the event of overdose or other adverse reaction. Permanent HAT programs have been established in the United Kingdom, Switzerland, the Netherlands, Germany and Denmark, with additional trial programs having been completed or currently taking place in Spain, Belgium and Canada. Findings from randomized controlled studies in these countries have yielded unanimously positive results, including: 1) HAT reduces drug use; 2) retention rates in HAT surpass those of conventional treatment; 3) HAT can be a stepping stone to other treatments and even abstinence; 4) HAT improves health, social functioning, and quality of life; 5) HAT does not pose nuisance or other neighborhood concerns; 6) HAT reduces crime; 7) HAT can reduce the black market for heroin; and, 8) HAT is cost-effective (cost-savings from the benefits attributable to the program far outweigh the cost of program operation over the long-run). States should consider permitting the establishment and implementation of a HAT pilot program. Nevada and Maryland have introduced legislation of this nature and the New Mexico Legislature recently convened a joint committee hearing to query experts about this strategy.

8. Evaluate the Use of Cannabis to Decrease Reliance on Prescription Opioids and Reduce Opioid Overdose Deaths: Medical use of marijuana can be an effective adjunct to or substitute for opioids in the treatment of chronic pain. Research published last year found 80 percent of medical cannabis users reported substituting cannabis for prescribed medications, particularly among patients with pain-related conditions. Another important recent study reported that cannabis treatment "may allow for opioid treatment at lower doses with fewer [patient] side effects." The result of substituting marijuana, a drug with less side effects and potential for abuse, has had profound harm reduction impacts. The Journal of the American Medical Association, for instance, documents a relationship between medical marijuana laws and a significant reduction in opioid overdose fatalities: "[s]tates with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws."Another working paper from the RAND BING Center for Health Economics notes that "states permitting medical cannabis dispensaries experienced a 15 to 35 percent decrease in substance abuse admissions and opiate overdose deaths." There is also some emerging evidence that marijuana has the potential to treat opioid addiction, but additional research is needed.

Harm Reduction

9. Establish and Implement Safe Drug Consumption Services: States and/or municipalities should permit the establishment and implementation of safe drug consumption services through local health departments and/or community-based organizations. California and Maryland have introduced legislation to establish safe drug consumption services, and the City of Ithaca, New York has included a proposal for a supervised injection site in their widely-publicized municipal drug strategy. In Washington State, the King County Heroin an Prescription Opiate Addiction Task Force has recommended the establishment of at least two pilot supervised consumption sites as part of a community health engagement program designed to reduce stigma and "decrease risks associated with substance use disorder and promote improved health outcomes" in the region that includes the cities of Seattle, Renton and Auburn.

10. Maximize Naloxone Access Points, Including Lay Distribution and Pharmacy Access, As Well As Immunities for Prescription, Distribution and Administration:Naloxone should be available directly from a physician to either a patient or to a family member, friend, or other person in a position to assist in an overdose, from community-based organizations through lay distribution or standing order laws, and from pharmacies behind-the-counter without a prescription through standing order, collaborative agreement, or standardized protocol laws or regulations. Though some states, including California, New York, Colorado and Vermont, among others, have access to naloxone at each of these critical intervention points, many others only provide naloxone through a standard prescription. Civil and criminal immunities should be provided to prescribers, dispensers and lay administrators at every access point. In addition, all first responders, firefighters and law enforcement should be trained on how to recognize an overdose and be permitted to carry and use naloxone. Naloxone should also be reclassified as an over-the-counter (OTC) medication. Having naloxone available over-the-counter would greatly increase the ability of parents, caregivers, and other bystanders to intervene and provide first aid to a person experiencing an opioid overdose. FDA approval of OTC naloxone is predicated on research that satisfies efficacy and safety data requirements. Pharmaceutical companies, however, have not sought to develop an over-the-counter product.88 Federal funding may be needed to meet FDA approval requirements.

11. Provide Dedicated Funding for Community-Based Naloxone Distribution and Overdose Prevention and Response Education: Few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs. The CDC, however, reports that, between 1996 and 2014, these programs trained and equipped more than 152,280 laypeople with naloxone, who have successfully reversed 26,463 opioid overdoses.89 Without additional and dedicated funding, community-based opioid overdose prevention programs will not be able to continue to provide naloxone to all those who need it, and the likelihood of new programs being implemented is slim. A major barrier to naloxone access is its affordability and chronic shortages in market supply, 90 which overdose prevention programs, operating on shoestring budgets, can have a difficult time navigating.

12. Improve Insurance Coverage for Naloxone: Individuals who use heroin and other opioids are often both uninsured and marginalized by the healthcare system.91 States should insure optimal reimbursement rates for naloxone to increase access to those who need it most – users themselves.

Overdose reversal drugs need to be made much more widely available -- and affordable. (health.pa.gov)

13. Provide Naloxone to Additional At-Risk Communities: People exiting detox and other treatment programs as well as periods of incarceration are at particularly high risk for overdose because their tolerance has been substantially decreased. After their period of abstinence, if they relapse and use the same amount, the result is often a deadly overdose. States should require overdose education and offer naloxone to people upon discharge from detox and other drug treatment programs and jails/prisons. The Substance Abuse and Mental Health Services Administration has declared that prescribing or dispensing naloxone is an essential complement to both detoxification services as well as medically supervised withdrawal. Vermont passed legislation making naloxone available to eligible pilot project participants who are transitioning from incarceration back to the community. In addition, there are other programs/studies that provide naloxone to recently released individuals on a limited basis, including in San Francisco, California, King County, Washington and Rhode Island.

14. Encourage Distribution of Naloxone to Patients Receiving Opioids: Physicians should be encouraged to prescribe naloxone to their patients and opioid treatment programs should inform their clients about naloxone, if prescribing or dispensing an opioid to them. Pharmacists should similarly be encouraged to offer naloxone along with all Schedule II opioid prescriptions being filled, for syringe purchases (without concurrent injectable medication), and for all co-prescriptions (within 30 days) of a benzodiazepine (such as Valium™, Xanax™ or Klonopin™) and any opioid medication. The Rhode Island Governor's Overdose Prevention and Intervention Task Force found that offering naloxone to those prescribed a Schedule II opioid or when co-prescribed a benzodiazepine and any opioid would have reached 86% of overdose victims who received a prescription from a pharmacy prior to their death, and could have prevented 58% of all overdose deaths from 2014 to 2015.

15. Expand Good Samaritan Protections: "Good Samaritan" laws provide limited immunity from prosecution for specified drug law violations for people who summon help at the scene of an overdose. But, protection from prosecution is not enough to ensure that people are not too frightened to seek medical help. Other consequences, like arrest, parole or probation violations, and immigration consequences, can be equal barriers to calling 911. States with Good Samaritan laws already on the books should evaluate the protections provided and determine whether expansion of those protections would increase the likelihood that people seek medical assistance.

16. End the Criminalization of Syringe Possession: Syringes should be exempt from state paraphernalia laws in order to provide optimal access to people who inject drugs. Twenty-two states criminalize syringe possession. Thus, even if there is a legal access point, such as pharmacy sales, paraphernalia laws still permit law enforcement to arrest and prosecute individuals in possession of a syringe. Public health and law enforcement authorities should not be working at cross-purposes.

17. Reduce Barriers to Over-The-Counter Syringe Sales and Permit Direct Prescriptions of Syringes: While the non-prescription, over-the-counter sale of syringes is now permitted in all but one U.S. state, access is still unduly restricted.States should evaluate the potential barriers to accessing syringes over-thecounter and implement measures to improve access. Moreover, doctors should be permitted to prescribe syringes directly to their patients, a practice few states currently permit.

18. Authorize and Fund Sterile Syringe Access and Exchange Programs; Increase Programs: States should explicitly authorize and fund sterile syringe access and exchange programs, and states that have already authorized them should evaluate how to increase the number or capacity of programs to ensure all state residents – whether in urban centers or rural communities -- have access to clean syringes, as well as evaluate any possible barriers to access such as unnecessary age restrictions.

19. Provide Free Public, Community-Level Access to Drug Checking Services: Technology exists to test heroin and opioid products for adulterants via GC/MS analysis, but it has so far been unavailable at a public level in the US (aside from a mail-in service run by Ecstasydata.org). Making these services available in the context of a community outreach service or academic study would lower the number of deaths and hospitalizations and also allow for real-time tracking of local drug trends.

Prevention

20. Establish Expert Panel on Opioid Prescribing: Though the CDC has issued guidelines for prescribing opioids for chronic pain, the guidelines are voluntary and are likely to exacerbate disparities in treatment that already exist. Research has shown, for example, that African Americans are less likely than whites to receive opioids for pain even when being treated for the same conditions. Moreover, the CDC guidelines only address prescribing practices for chronic pain, not prescribing practices more broadly. States should accordingly establish an expert panel to undertake an assessment as to whether prescribing practices, such as co-prescriptions for benzodiazepines and opioids or overprescribing of opioids, have contributed to increased rates of opioid dependence, and, if so, the expert panel should develop a plan to address any such linkages as well as any treatment disparities. The plan must account for the potential negative effects of curtailing prescribing practices or swiftly reducing prescription opioid prescribing volume. A task force in Rhode Island found that while changes in opioid supply can have the intended effect of reducing availability of abuse-able medications, they have also been linked to an increase in transition to illicit drug use and in more risky drug use behaviors (e.g., snorting and injecting pain medications). The plan must also account for chronic pain patients, particularly those already underserviced, and not unduly limit their access to necessary medications. Finally, to the extent prescribing guidelines are issued as part of the plan, they should be mandatory and applied across the board.

21. Mandate Medical Provider Education: States should mandate that all health professional degree-granting institutions include curricula on opioid dependence, overdose prevention, medication-assisted treatment, and harm reduction interventions, and that continuing education on these topics be readily available.

22. Develop Comprehensive, Evidence-Based Health, Wellness, and Harm Reduction Curriculum for Youth: State education departments, in conjunction with an expert panel consisting of various stakeholders that ascribe to scientific principles of treatment for youth, should develop a comprehensive, evidence-based health, wellness, and harm reduction curriculum for use in schools that incorporates scientific education on drugs, continuum of use, and contributors to problematic drug use (e.g., coping and resiliency, mental health issues, adverse childhood experiences, traumatic events and crisis), as well as how reduce harm (e.g., not mixing opioids with benzodiazepines). Education departments should also establish protocols and resources for early intervention, counseling, linkage to care, harm reduction resources, and other supports for students.

CRIMINAL JUSTICE

23. Establish Diversion Programs, Including Law Enforcement Assisted Diversion (LEAD): LEAD is a pre-booking diversion program that establishes protocols by which police divert people away from the typical criminal justice route of arrest, charge and conviction into a health-based, harm-reduction focused intensive case management process wherein the individual receives support services ranging from housing and healthcare to drug treatment and mental health services. Municipalities should create and implement LEAD programs and states and the federal government should provide dedicated funding for such programs. Various other forms of diversion programs exist and can be implemented should LEAD prove unsuitable to a particular population or municipality.

24. Decriminalize Drug Possession: Decriminalization is commonly defined as the elimination of criminal penalties for drug possession for personal use. In other words, it means that people who merely use or possess small amounts of drugs are no longer arrested, jailed, prosecuted, imprisoned, put on probation or parole, or saddled with a criminal record. Nearly two dozen countries have taken steps toward decriminalization. Empirical evidence from the international experiences demonstrate that decriminalization does not result in increased use or crime, reduces incidences of HIV/AIDs and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. All criminal penalties for possession of small amounts of controlled substances for personal use should be removed.

Connecticut Takes Another Step Toward Adding More Qualifying Conditions. Consumer Protection Commissioner Michelle Seagull announced last Friday that she would follow a recommendation from the Medical Marijuana Program Board of Physicians to include three new conditions among the list of qualifying conditions for medical marijuana use. They are hydrocephalus with intractable headaches, intractable migraines, and trigeminal neuralgia. Seagull will now draft a new regulation by the end of the month, and after that, there will be a 30-day public comment period, then a review by the office of the attorney general, and then the approval of the Regulation Review Committee of the General Assembly. The whole process could take another year.

Florida Legislature Passes Medical Marijuana Implementation Bill. Lawmakers used a special session to come to an agreement on how to handle medical marijuana last Friday. Under the proposal approved by the legislature, which Gov. Rick Scott (R) says he will sign, the state will gain an additional ten medical marijuana operators within four month. Each operator can operate up to 25 dispensaries across the state. But the bill also bans the smoking of medical marijuana even though the constitutional amendment approved by voters last November expressly included a provision that allows smoking. That has led Orlando lawyer John Morgan, who largely bankrolled the amendment, to vow to sue the state over the no-smoking provision.

Vermont Governor Signs Medical Marijuana Expansion Bill. Gov. Phil Scott (R) last Thursday signed into law Senate Bill 16, which expands the list of qualifying conditions for medical marijuana. The new conditions added are Parkinson's disease, Crohn's disease, and PTSD. The new law also increases the number of dispensaries in the state from four to five.

Asset Forfeiture

Colorado Governor Signs Asset Forfeiture Reform Bill. Gov. John Hickenlooper (D) last Friday signed into law a civil asset forfeiture reform bill, House Bill 17-1313, which blocks state and local law enforcement from handing forfeiture cases off to the feds if the total value of the seized property is less than $50,000. In cases prosecuted by the federal government, the local law enforcement agency receives 80% of the proceeds, while under state law, the proceeds go to a general fund. Under the new law, police must also report all asset forfeitures and how they were used to the state.

International

Facing Mass Protests, Georgian Prime Minister Vows to Soften Harsh Drug Policies. After large crowds gathered in the capital Tbilisi to protest the arrest of two rappers who claim police planted drugs on them, Prime Minister Giorgi Kvirikashvili unexpectedly weighed in a vowed to soften the country's drug laws. "I call on the parliament to accelerate the work [on the issue of softening drug legislation] in order at last to adopt a modified and humane law for the fall session in line with European standards," said in a statement published on the government website.

New York lawmakers are beginning a new push for marijuana legalization, the Florida Senate has passed a medical marijuana implementation bill, LA County Sheriff's deputies begin carrying the overdose reversal drug Naloxone, and more.

The LA County Sheriff's Department becomes the largest police agency in the land to carry Naloxone. (pa.gov)

Marijuana Policy

New York Lawmakers Prepare Legalization Effort. State Sen. Liz Krueger (D-Manhattan) and Rep. Crystal Peoples-Stokes (D-Buffalo), along with advocates organized by the Drug Policy Alliance, will hold a press conference Monday to announce the reintroduction of the Marijuana Regulation and Taxation Act, Senate Bill 3040 and its Assembly companion, Assembly Bill 3506. The legislation would establish a legal market for adult-use cannabis in the state, with marijuana taxed and regulated in a fashion similar to how alcohol is regulated for adults over 21.

Rhode Island Legal MJ Backers Propose Compromise. Lawmakers trying to salvage a marijuana legalization effort have proposed a two-stage process where marijuana possession would be legalized first, but the legalization of marijuana commerce would come later. The proposal from Sen. Joshua Miller (D-Cranston) and Rep. Scott Slater (D-Providence) does not have the support of state Senate and House leaders, though. They are supporting a rival bill that would delay legalization by creating a legislative commission to study the issue.

Medical Marijuana

Arizona Attorney General Asks State Supreme Court to Reinstate Ban on Campus Medical Marijuana. Attorney General Mark Brnovich (R) has asked the state Supreme Court to review an appeals court ruling that struck down a ban on medical marijuana on college campuses. The state is arguing that the legislature had the right to alter the voter-approved medical marijuana law so that college students with medical marijuana cards could face felony arrests for possession of any amount of marijuana.

Florida Senate Passes Law Implementing Medical Marijuana. The state Senate on Friday approved a bill that would implement the state's constitutional amendment expanding the use of medical marijuana on a vote of 28-8. A similar bill fell apart during the legislature's regular session, but now, during a special session, it is moving. It must still past the House and be signed into law by Gov. Rick Scott (R) to become law. The bill would cap the number of medical marijuana cultivation operations at 25 statewide and it would not allow for the smoking of medical marijuana.

Harm Reduction

Los Angeles County Deputies to Start Carrying Naloxone. The Los Angeles County Sheriff's Department is about to become the largest law enforcement agency in the US to equip its members with the life-saving opioid overdose reversal drug. Some 600 Naloxone spray kits are being handed out this week, and the department plans to get the kits in the hands of 3,000 of its deputies by year's end.

No let up in prohibition-related violence along the Rio Grande. (Borderlands Beat/Creative Commons)

Marijuana Policy

Rhode Island Legalization Commission Gets Expanded. The House Judiciary Committee has voted to expand the membership of a commission studying legalization by adding five more people. The five new members will add heft to the commission's pro-legalization contingent. They include the head of the local NAACP branch, a representative of Doctors for Cannabis Regulation, a criminal defense attorney, and the director of the local chapter of Direct Action for Rights and Equality. This brings the size of the commission to 22. The panel would report recommendations on legalizing marijuana to the General Assembly by March 2018.

Drug Policy

Wisconsin Seeks to Keep Locking Up Pregnant Women Suspected of Drug Use Despite Court Ruling. The state Department of Justice has asked the 10th US Circuit of Appeals to let it continue to apply a law allowing it to detain pregnant women it suspects of drug use even though a US district court judge struck it down in April. State officials first sought an emergency stay to block the ruling while they appeal, but when that was denied Monday, on Tuesday they asked to continue to apply the law to pending cases while it appeals the denial to the US Supreme Court.

International

British Public Health Group Calls for Pill Testing at Festivals. Citing the danger of "serious health harm" from stronger ecstasy in the UK, the Royal Society for Public Health is calling for a program to allow festival goers to test their drugs on site. The society reported than a one-off pill testing pilot program last year resulted in 18% of people bringing their drugs in deciding to through them in the garbage after they turned out to be counterfeit or adulterated.

Mexico Drug War Violence Continues to Roil Reynosa. At least 50 people have been killed in the past month in the Mexican border town of Reynosa, just across the Rio Grande River from McAllen, Texas, according to unofficial counts in local media. Most of the dead are reportedly gunmen from rival factions of the Gulf Cartel, who are fighting for control of local drug trafficking routes, but at least one civilizan -- a taco cart vendor -- is among the dead.